1 Project Summary/Abstract: 2 3 An experienced team of clinicians, information technology experts, public health leaders, and communications 4 specialists are proposing Project GIVEASHOT - Georgia Initiative to VaccinatE during Admission or SHOrt 5 Stay VisiTs. The work takes place at Emory University Midtown Hospital and Grady Health Systems, distinct 6 systems serving large, diverse and medically underserved patient populations in Atlanta. Goals are to identify 7 and analyze immunization gaps of adults in inpatient and short stay (24-hour observation and clinical decision) 8 units and to develop and assess interventions based on CDC's Standards for Adult Immunization Practices to 9 close those gaps. Work will occur in three phases over 3 years. Phase I addresses Specific Aim 1: evaluate 10 existing vaccination policies, practices and vaccination coverage in inpatient and short stay units. We will 11 conduct an environmental scan and interviews with key informants (administration, medicine, nursing, 12 pharmacy, information technology) to understand policies and practices for determining immunization needs, 13 accessing the Georgia Immunization Registry (GRITS), and delivering and documenting vaccines (Objective 14 1A). We will review electronic health record (EHR) databases and a retrospective sample of 1000 patient 15 records at each institution to measure prevalence of needed, delivered, and documented vaccines; records will 16 be compared to GRITS to assess vaccine coverage and information sharing (Objective 1B). Interviews and 3- 17 person focus groups will measure provider and patient knowledge, attitudes and beliefs on inpatient 18 vaccination of adults (Objective 1C). In Phase II, we will design and implement interventions based on Phase I 19 findings, including: 1) a two-way link with GRITS that allows rapid information exchange, 2) electronic systems 20 to create customized standing orders for all vaccines each patient needs, 3) AFIX-like reports generated 21 quarterly from EHR systems to track vaccination administration by unit and admitting service that will be given 22 to hospital leadership and clinical staff, and 4) educational materials for providers and patients. Phase III will 23 address Specific Aim 2: evaluate impact of these interventions on vaccine delivery. We will evaluate the link 24 between the EHR systems and GRITS to measure the speed and completeness of information exchange 25 (Objective 2A), assess whether the educational efforts, new standing orders systems, and AFIX-like reports 26 have changed provider knowledge, beliefs, and attitudes through focus groups and interviews (Objective 2B), 27 and use EHR databases and a prospective review of 1000 patient records at each institution to reassess 28 inpatient vaccination coverage levels at admission, vaccines given during admission, documentation, and 29 associated costs of the interventions (Objective 2C). Analysis of data extracted from patient records in Phases 30 I and III will determine whether assessment of vaccine needs, recommendations, delivery, and documentation 31 improved significantly following the interventions. Project GIVEASHOT will generate information on gaps in 32 inpatient vaccine delivery and methods for improvement that can be adopted by U.S. hospitals. 33